Pancreatic Cancer

The main risk factor for pancreatic cancer is smoking. About 30% of pancreatic cancers are thought to be a direct result of cigarette smoking. Other risk factors include:

• Age (most often seen in people older than 60)
• Whether a person is a male or female (men are 30% more likely to develop pancreatic cancer than women)
• Chronic pancreatitis
• Diet (a diet high in meats and fats appears to increase risk)
• Diabetes mellitus
• Exposure to industrial chemicals, such as certain pesticides and petroleum products
• Family history (an inherited tendency may be a factor in 5% to 10% of cases)

It should be noted that most people who have known risk factors do not get pancreatic cancer, and many who do get pancreatic cancer have none of these risk factors.

Early symptoms of pancreatic cancer are often either absent or subtle. They include:

• Abdominal and/or back pain
• Pruritus
• Nausea
• Loss of appetite
• Unexplained weight loss
• Jaundice

Since these symptoms are seen in other conditions besides cancer, they may be ignored or missed in the early stages. By the time chronic pain, nausea, vomiting, malabsorption, and, in some rare instances, problems with blood sugar control surface and are recognized, the pancreatic cancer has usually spread.

There are no established laboratory tests for the early detection or diagnosis of pancreatic cancer. Diagnosis is usually made by imaging tests and a tissue biopsy, and most cancers have already metastasized by this time.

Some imaging tests that may be used to detect pancreatic cancer include:

• Computed tomography (CT) scan: useful for detecting pancreatic masses and checking for metastasized cancer
• Endoscopic retrograde cholangiopancreatography (ERCP): a flexible scope is inserted into the pancreatic duct and a dye is injected. X-rays can then reveal abnormalities in the structure of the pancreas due to the presence of a tumor. If abnormal areas are identified, a biopsy can be performed.
• Magnetic resonance cholangiopancreatography (MRCP): a type of magnetic resonance imaging (MRI) used to see the pancreas, its ducts, and the bile ducts more clearly; often used before or instead of ERCP because it is faster and noninvasive; also useful in distinguishing pancreatitis from pancreatic cancer

For more information on imaging studies, see RadiologyInfo.org.

Laboratory tests that may show abnormal results but are not diagnostic of pancreatic cancer include the following:

• Comprehensive metabolic panel: a group of tests that may be used to evaluate liver and kidney function and to determine why someone is jaundiced
• CA 19-9 (Cancer antigen 19-9): a tumor marker for pancreatic cancer; it may be used to distinguish pancreatic cancer from other cancers or to monitor for cancer recurrence. It is not currently useful for detection or diagnosis by itself because non-cancerous conditions can cause elevated CA 19-9 levels. Recent research, however, suggests that it may be useful for early detection of pancreatic cancer when combined with a promising new microRNA-detecting test that is still under investigation.
• CEA (Carcinoembryonic antigen): a tumor marker used as a monitoring tool
• Amylase: blood level may be elevated
• Other tests, such as fecal fat, stool trypsin, serum trypsinogen, and lipase, may be ordered to help evaluate how well the pancreas is functioning and to determine whether pancreatic enzyme supplementation is necessary.

A biopsy may be used to confirm a diagnosis of cancer through examination of pancreatic tissue.

Treatment of pancreatic cancer is based on establishing what stage the cancer is in by determining how much of the pancreas is involved and whether the cancer has spread. This may be done using a formal staging/naming system or by categorizing the cancer into one of the following types: resectable (can be surgically removed because still located within the pancreas), locally advanced (spread into nearby organs and not resectable), or metastatic (spread to distant organs).

Unfortunately, pancreatic cancer can be categorized as resectable less than 15% of the time. How much surgery should be done depends on where the tumor is, its size, how far it has spread, and the condition of the affected person's health.

Pancreatic surgery is very difficult. It requires an experienced surgeon, is associated with significant complications, and requires several weeks of recovery time. Procedures intended to treat pancreatic cancer include the Whipple procedure, distal pancreatectomy, and total pancreatectomy. For more on these, see the Johns Hopkins Kimmel Cancer Center's page on Pancreatic Cancer Surgery.

Radiation and chemotherapy may be used to treat pancreatic cancer and typically are necessary because often tiny, undetectable amounts of a tumor will have spread by the time a surgery is done. Regrettably, pancreatic cancer does not respond well to current treatments. Gemcitabine and 5-fluorouracil (5-FU) are the most commonly used chemotherapy agents. They may be used alone or in combination with other drugs.

Research into new treatment options known as "targeted therapies" is an active and ongoing field. Attempts to develop new drugs that have specific targets are meant to have fewer side effects than current chemotherapy drugs. Examples include pancreatic cancer growth factor inhibitors, anti-angiogenesis factors that block new blood vessels essential for cancer growth, and drugs that target substances involved in the spread of pancreatic cancer.

For those with recurring or inoperable pancreatic cancer, palliative (comfort-oriented) care is the primary priority. Radiation, chemotherapy, and surgery may be used to help relieve pain. Surgery may also be performed to cut nerves to help relieve pain that is resistant to other measures.

People with inoperable pancreatic cancer may want to consider enrollment in clinical trials that assess new treatments. Learn more about clinical trials at the National Cancer Institute website.